SUMMARY Neuropsychological deficits following mild head injury have been reported recently in the literature. The purpose of this study was to investigate this issue with a strict methodological approach. The neuropsychological performance of 50 mildly head injured patients was compared with that of 50 normal controls chosen with the case-control approach. No conclusive evidence was found that mild head injury causes cognitive impairment one month after the trauma.Effects of head injury on mental functions have usually been studied in patients with severe trauma. Studies on the consequences of mild injury are much rarer, in spite of the fact that these patients frequently complain of difficulties in concentration and memory and poor intellectual efficiency.Gronwall and Wrightson' found reduced efficiency in 10 patients with mild head trauma and subjective post-concussion syndrome as revealed by the PASAT test (which requires the patient to sum a series of numbers given at a rapid rate) in comparison to the performance of a patient group with head injury of the same degree but without the subjective syndrome. Altered PASAT scores were found in the initial phase, and returned to normal within 30-35 days. In 1981 Rimel et a12 published an exhaustive analysis on 538 patients with mild head injury defined on the basis of the following parameters: loss of consciousness for less than 20 min, Glasgow Coma Scale (GCS) values ranging between 13 and 15, length of hospitalisation less than 48 hours. Follow-up was performed on 424 patients 3 months after the trauma: of these 79% complained of persistent headaches, 59% had memory loss, and 34%

We investigated pressures at 1 cm intervals along the carpal tunnel in 39 patients with carpal tunnel syndrome (CTS) and 12 controls. Pressures were measured for relaxed and gripping hand positions in combination with neutral, extended, and flexed wrist positions. Patient pressures exceeded control pressures, were below the previously reported 30 mmHg threshold for four of five locations in the relaxed neutral position and were typically greater in extension than in flexion. In the neutral position, both patient and control pressures were slightly above threshold levels just distal to the tunnel. Maximum intratunnel pressures were generally found in the central part of the tunnel and minimum pressures in the distal tunnel. Gripping hand pressures in the tunnel were lowest with the wrist flexed. In both controls and CTS patients, only in the neutral wrist and relaxed hand positions were pressures highest at the point where nerve conduction studies have indicated the nerve is most likely to be compromised (in the midpalm just distal to the distal margin of the carpal tunnel).

SUMMARY Thirty-five patients and corresponding matched controls were investigated between 5 and 17 months from mild head trauma using the Self Rating Depression Scale and the State-Trait Anxiety Inventory. The findings indicate that compared with an appropriate control group mild head injured patients are at risk of developing depression, whereas their liability to anxiety is not increased. Our results strongly suggest that all head injured patients should be screened for depression.The postconcussion syndrome frequently occurs after mild head injury (MHI). The term postconcussion syndrome is reserved for patients who have persisting subjective symptoms resulting from cerebral concussion. We know that head injuries that initially seem mild can occasionally cause severe complications. Also a blow that fails to produce any loss of consciousness can cause a pronounced temporary impairment of recent memory, known as posttraumatic amnesia, without any other neurological signs. The patient with posttraumatic nervous instability is often intolerant of noise and crowds. Inability to concentrate, a feeling of nervousness, fatigue, apprehension complete the clinical picture. In contrast to this multiplicity of subjective symptoms, memory and other intellectual functions show little or no impairment on detailed neuropsychological testing,1 except for a slowing of both simple and choice reaction times I month after injury.2 The resemblance of postconcussion symptoms to those of anxiety and depression is at once apparent. The syndrome may persist for months or years, but usually the symptoms lessen as time passes.Data from the literature show that within 3 months of injury 51-84% complain of posttraumatic symptoms.3"4 After 6 months the figure is 49%,5 after one year 15_33%6 7 and after 3 years 15%.7Address for reprint requests: Dr Rudolf Schoenhuber, Clinica Neurologica, Universita di Modena, Largo del Pozzo, 1 41100 Modena, Italy. Received 28 July 1987 and in revised form 18 December 1987. Accepted 22 January 1988Disagreement still prevails with regard to the aetiology and pathogenesis of the postconcussion syndrome. Some investigators believe that it is essentially due to traumatic brain lesion,46 8-10 while others suggest that neurosis, anxiety, or outright malingering could be the explanation for persisting subjective symptoms in postconcussion syndrome patients. 11 -13The question of whether patients suffering from MHI are at risk of developing affective disorders has not yet been fully explored. Depression and anxiety are the most common symptoms in these patients. The purpose of the present study was, therefore, to assess the incidence of affective symptoms among MHI patients and to determine if the anxieties that result have any unique features and to consider the possible relationship between anxiety and depression.

Using the constant infusion technique, we have measured the pressures within the carpal tunnel in 30 hands in patients with carpal tunnel syndrome and in 4 hands in control subjects. The mean pressure in the normal, control subjects was 13 mmHg and in the carpal tunnel syndrome patients 26 mmHg. In the normal subjects the pressures did not change along the canal, whereas in the patients the values in the middle section were 50 percent higher than the mean. Our results correspond to reports of computed tomography and magnetic resonance recordings of nonuniform dimension of the carpal tunnel.

As part of a larger epidemiological study [Neuro-Epidemiology Project South-Tyrol (NEPT)], we investigated the accuracy of a mail questionnaire for parkinsonism in two languages (German and Italian). We administered the instrument to 40 randomly selected subjects with parkinsonism (Italian-speaking, n = 20; German-speaking, n = 20), attending our Parkinson's disease clinic regularly. Each patient was matched by age, sex and language with a subject without parkinsonism residing in the same South-Tyrol Province in Northern Italy. Subjects free of parkinsonism were recruited randomly from two group practices collaborating in the NEPT study. A questionnaire containing nine symptom questions and two additional questions about the patient's diagnosis of parkinsonism and/or treatment was mailed to each subject's home. Forty subjects with parkinsonism and 36 without parkinsonism participated in the study. All nine symptom items showed significant differences between affected and unaffected individuals. A combination of any three questions yielded the best balance between sensitivity (95%) and specificity (89%). There were no differences between the German- and Italian-speaking groups. We demonstrated the usefulness of a simple questionnaire for validating the diagnosis of parkinsonism irrespective of the primary native language.

An Italian version of the patient-rated wrist/hand evaluation (PRWHE) questionnaire was obtained through the standardized process of cross-cultural adaptation. The PRWHE-Italian (IT) was tested on 63 patients in order to evaluate comprehension, reliability and validity as correlated to the validated version of the disabilities of the arm shoulder and hand (DASH)-IT and SF-36. No patients had difficulty completing the PRWHE-IT questionnaire. Psychometric testing demonstrated high reliability (Cronbach's alpha coefficient = 0.9607) and internal and external validity (Pearson correlation coefficient r = 0.927 with PRWHE, r < 0.810 with DASH and r < -0.476 with SF-36). The Italian version of the PRWHE has equivalent evaluation capacities to the original English version and is a reliable functional outcome measurement instrument for wrist and hand disorders.

In 19 carpal tunnel syndrome (CTS) patients and 4 control subjects a catheter was introduced into the carpal tunnel and slowly retracted in 5 mm steps. Pressure was measured with the continuous infusion technique. In the same group of patients and controls, median nerve antidromic sensory action potential (aSAP) was detected intraoperatively stimulating proximally (S1), in the center (S2), and distally (S3) to the carpal tunnel and recording from the third finger (R). Sensory conduction velocity (SCV) and aSAP amplitude were considered in S1-S2, S2-S3 and S3-R segments. The intracarpal tunnel pressure was significantly higher in CTS patients than in controls, with the highest values located between 25 and 35 mm distal to the proximal border of the flexor retinaculum. SCV and aSAP amplitude were also decreased most often in the distal part (S2-S3) of the carpal tunnel.

Sensory conduction velocities of the median nerve before, during and after operation were compared in nine patients with carpal tunnel syndrome and four controls, in order to evaluate the prognostic value of the pre-operative and intra-operative findings. Sensory conduction velocity was higher after operation than before in all patients (mean difference 31.33%), but not in control subjects. One patient showed a dramatic increase of 157% immediately after decompression. Comparing the intra-operative with the post-operative findings all patients but one showed an increase of antidromic sensory conduction velocity (mean 44.37%), while in control subjects again minimal changes were found (mean -4.25%). The study confirms the high diagnostic value of the pre-operative antidromic sensory conduction velocity findings. However, the prognostic value of both pre-operative and intra-operative ASCV findings is low.